From 9 through 30 April 2019, the National International Health Regulations (IHR) Focal Point of Saudi Arabia reported nine additional cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection, including three deaths. Of the nine cases reported, five were associated with ongoing clusters in three cities. Three cases (including one death) were reported in Alkhafji city in the Eastern region of Saudi Arabia, one case in Alderb city in Jazan region and one case in Alkharji city in Riyadh region of Saudi Arabia. Details of the ongoing clusters are available in the Disease Outbreak News published on 9 May 2019.

From 2012 through 30 April 2019, a total of 2428 laboratory-confirmed cases of MERS-CoV infection and 839 associated deaths were reported globally to WHO under the IHR. The associated deaths reported to WHO were identified through follow-up with affected member states.

WHO risk assessment

Infection with MERS-CoV can cause severe disease resulting in high morbidity and mortality. Humans are infected with MERS-CoV from direct or indirect contact with infected dromedary camels. MERS-CoV has demonstrated the ability to transmit between humans, especially from close unprotected contact with infected patients. So far, the observed non-sustained human-to-human transmission has occurred mainly in health care settings.

The notification of these additional cases does not change WHO’s overall risk assessment of MERS. WHO expects that additional cases of MERS will be reported from the Middle East, and that cases will continue to be exported to other countries by individuals who might acquire the infection after exposure to dromedary camels, animal products (e.g. consumption of camel’s raw milk), or humans (e.g. in a health care setting).

WHO continues to monitor the epidemiological situation and conducts risk assessment based on the latest available information.

From 14 February through 31 March 2019, the National IHR Focal Point of Saudi Arabia reported 22 additional cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection, including four deaths, associated with the outbreak in Wadi Aldwasir. Of the 22 cases, 19 were reported from Wadi Aldwasir city including two healthcare workers. The remaining three cases, which are epidemiologically linked to the outbreak, were healthcare workers from a hospital in Khamees Mushait city, Asir region.

Since the beginning of this outbreak in January 2019, a total of 61 MERS-CoV cases, with a case fatality ratio of 13.1% (8/61), have been reported in Wadi Aldwasir city. The median age of reported cases was 46 years (range 16 to 85 years). Of the 61 cases, 65% (n=46) were male, and 23% (n = 14) were health care workers.

Investigations into the source of infection of the 61 cases found that 37 were health-care acquired infections, 14 were primary cases presumed to be infected from contact with dromedary camels and the remaining (10) infections occurred among close contacts outside of health care settings. As previously reported, two human to human transmission amplification events took place at a hospital during this outbreak.

April 01, 2019

The Centre for Health Protection (CHP) of the Department of Health is today (April 1) closely monitoring 19 additional cases of Middle East Respiratory Syndrome (MERS), reported to the World Health Organization (WHO) by the Kingdom of Saudi Arabia (KSA) from February 1 to 28. The CHP again urged the public to pay special attention to safety during travel, taking due consideration of the health risks in the places they visit.

According to the WHO, among the 17 male patients and two female patients, aged 24 to 94, 13 had underlying illnesses, nine had exposure to camels and consumed camel milk, two had contact with previously confirmed patients, and three had passed away.

"We will maintain close communication with the WHO and relevant health authorities," a spokesman for the CHP said.

"As countries in the Middle East, particularly the KSA, continue to report MERS cases from time to time, travellers should refrain from going to farms, barns or markets with camels and avoid contact with sick persons and animals, especially camels, birds or poultry. Most of the cases reported in the Middle East had history of exposure to camels, consumption of camel milk or contact with other MERS patients," the spokesman said.

From 1 through 28 February 2019, the National IHR Focal Point of Saudi Arabia reported 68 additional cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection, including 10 deaths. Of the 68 MERS cases reported in February, 19 cases occurred in cities other than Wadi Aldwasir.

This Disease Outbreak News update describes the 19 cases. Among these cases, fifteen were sporadic, and four were reported as part of two unrelated clusters. Cluster 1 involved two cases in Buridah city; and Cluster 2 involved two cases in Riyadh city. The link below provides details of the 19 reported cases.

MERS-CoV cases reported from 1 February through 28 February 2019 xls, 116kb

A separate Disease Outbreak News will provide an update on the outbreak in Wadi Aldwasir which affected 49 cases and resulted in seven deaths in February making a total of 52 cases since the onset of the outbreak.

From 2012 through 28 February 2019, the total number of laboratory-confirmed MERS cases reported globally to WHO is 2374 with 823 associated deaths. The global number reflects the total number of laboratory-confirmed cases reported to WHO under IHR to date. The total number of deaths includes the deaths that WHO is aware of to date through follow-up with affected member states.

Assistant Undersecretary of the Ministry of Health for Preventive Health, Dr. Abdullah Assiri, said that the infection control procedures in the Kingdom's hospitals are identical and applied in any health facility, even in primary health care centers.

Asiri said in an interview with Al Arabiya television that there is a so-called respiratory screening. This is a standard procedure that must be in the emergency entrances in every health facility where there is a health worker who receives all those coming to the emergency.

If there is contact with camels or not, and when suspected in any case takes a separate path and has a place isolated from the rest of the patients in the emergency departments until the sample is taken, and make sure that the disease is not Corona.

He added that then if there is a diagnosis of the disease, the patient is transferred to rooms called negative pressure chambers, and is located in the sections of normal hypnosis, as well as intensive care departments according to the health status of the patient.

Asiri said: "The most important step is the critical step is the beginning of suspicion when there is a valid suspicion and diagnosis of the situation early, then the procedures are simple, and they are just wearing personal condoms and the normal sleeves of the non-surgical patient and jumps, And change between each patient and another."

He pointed out that "the problem that always results in infections within the health facilities delay in attention or suspicion in these cases, is that they are not isolated by the right time and this also has many reasons, the most important that some patients have chronic diseases do not show a high degree So the medical team may be treating the situation in a timely manner."

In response to the question, "Why is the Wadi Al-Dawasir specifically the largest proportion in Saudi Arabia?" Dr. pointed out that this ratio is only for the year 2019, but in the rest of the years almost all regions of the Kingdom had its share, and Wadi Al-Dawasir by the market is the second largest camel market in the Kingdom of Arabia and the Gulf, and there is very great friction between citizens and camels that spread throughout the Kingdom, Of the positive; which led to the creation of cases and their epidemiological association.

Asiri said that one case of infection resulted in a series of injuries: 41 cases, which were the main cause of the increase in the number of cases in Wadi Al-Dawasir, where the recovery of 31 cases, and (2) under medical care.

Pointing out that there is still a significant activity of the virus in society, resulting in a number of initial cases in a number of regions of the Kingdom.

Human infection with Middle East Respiratory Syndrome Coronavirus (MERS-CoV) is driven by recurring dromedary-to-human spill-over events, leading decision-makers to consider dromedary vaccination. Dromedary vaccine candidates in the development pipeline are showing hopeful results, but gaps in our understanding of the epidemiology of MERS-CoV in dromedaries must be addressed to design and evaluate potential vaccination strategies.

We systematically reviewed the published literature reporting seroprevalence and/or prevalence of active MERS-CoV infection in dromedary populations from both cross-sectional and longitudinal studies, including 60 studies in our qualitative syntheses.

MERS-CoV seroprevalence increased with age up to 80-100% in adult dromedaries supporting geographically wide spread endemicity of MERS-CoV in dromedaries in both the Arabian Peninsula and countries exporting dromedaries from Africa. The high prevalence of active infection measured in juveniles and at sites where dromedary populations mix should guide further investigation – particularly of dromedary movement – and inform vaccination strategy design.

Mike Coston at Avian Flu Diary has been doing an extraordinary job of covering MERS for years, and never more so than in this year's outbreak. By all means check his posts for both breaking news and the detailed background he provides.

The Ministry of Environment, Water and Agriculture has quickly closed the camel market in Wadi Al-Dawasar, the largest camel market in the Gulf, following the continued presence of human infections from the Middle East respiratory syndrome.

According to a letter obtained earlier, Environment today directed the competent authorities in Wadi Al-Dawasir to quickly close the camel market, after recording positive cases in camel samples taken, and the urgent need to reduce the sources of spread of disease and injury among camel owners and workers and visitors to the market, which is the largest camel markets in the Gulf.

The letter confirmed the recognition of the Ministry of Agriculture after the registration of positive cases in samples taken from camels, while trying hard to quickly shut down as a precaution until the epidemiological situation stabilizes.

The Ministry of Health Command and Control Center announced that 23 MERS cases have recovered in the province of Wadi Al-Dawaser, noting that since the emergence of cases, the Center took all precautionary and preventive measures.

The management of Afif General Hospital decided to temporarily reduce the visit to the ICU for half an hour, thus preventing the spread of the Corona virus.

The hospital announced that it will not allow visits to the isolation sections, while ensuring that the number of visitors to the patient does not exceed two people at the same time, in addition to preventing children from entering the hypnotic sections, and advised those with flu and flu symptoms not to visit patients.

The director of public relations and media Sultan al-Mughairy said that the hours of the visit were from 4 pm to 6 pm. It was also decided to reduce the visit to the intensive care unit to be half an hour, while preventing the children from entering the hypnotic sections. And to avoid the risk of infection from viruses.

He added that all these measures are preventive and aimed at protecting the patients and the visiting and will be worked out until further notice.

These precautionary measures came after the announcement of the Health Ministry's command and control center yesterday that four new cases of Corona virus were recorded, including one in Afif General Hospital.

Over the past seven years, 775 people in Saudi Arabia have died of Corona, which appeared in the country in 2012, and since then the kingdom has not succeeded in eradicating it.

Deaths continue, as well as injuries that health authorities can save from death, make the local media scream loudly, trying to reach out to the highest authorities in the country and wonder why the disease has not been eradicated. The authorities have put in place a plan to destroy it since Years!

The newspaper "Okaz", which is a newspaper close to the Government of Riyadh wondered, in its issue on Sunday (February 17), on why not to eliminate Corona.

"At a time when the Ministry of Health has intensified its outreach through social media to alert to the severity of the Middle East Respiratory Syndrome (CR), she said that "There is currently no approved drug for Corona treatment.

"But the most important question that many people have been discussing is why the disease has disappeared globally and spread in Saudi Arabia, especially in the recent period?"

"The absence of the main source of the disease, which is camels, may be the reason why the virus has not settled in these countries," the newspaper said, citing the director general of the Saudi Center for Patient Safety, "The characteristics of camels in Europe are completely different from those of Arab camels."

The doctor confirmed that there is a relationship between camels and HIV; which is easy to transfer to humans, noting that the other reason for the increase in the number of injuries currently is the period of breeding camels in the months (February and March), which are the seasons with the highest individual cases in some areas.

But shepherds, despite their daily contact with camels, do not get the disease, according to Okaz, which is explained by Halwani immunity. "Some pastoralists may not have symptoms if they are infected because of their long life with camels, especially older people with chronic diseases."

Halawani also says that "the quality of the strain of the virus itself may vary in terms of virility and susceptibility and its ability to cause imbalances and complications associated."

"The increased incidence of Coronas may have been due to the development of diagnostic tests in infectious diseases, the presence of laboratory tests, and the experience gained by doctors in Saudi Arabia, which contributed to the detection of cases as accurately and as quickly as possible," he said, hinting that the virus would have been more widespread had it not been for this development, which is spoken by the doctor.

The latest deaths of the "Corona" virus in Saudi Arabia occurred on Saturday (17 February), where the local newspaper "Riyadh" reported the deaths of two injured, one recorded in the "Valley Dawser" in the capital Riyadh, and another in the city, "Khamis Mushait" (southwest) during the 24 Hours ago.

She pointed out that the total number of hypnotized or isolated cases in the current time in different regions of the Kingdom 32 cases, including 6 for health practitioners (without symptoms).

Deaths of infected people

The death toll of the virus has risen to 775 people since its emergence in the Kingdom in 2012, according to the same source.

Many scientists fear that the virus could mutate to become more spread among humans. For this reason, scientists are trying to develop vaccines to prevent human transmission, as well as to reduce the virus's spread in camels.

Scientists believe that Arabian camel is the first source of transmission of the Corona virus to humans. The virus is particularly prevalent in young camels, with infections leading to mild symptoms similar to common colds.

According to researchers, the virus is transmitted to humans when they have contact with the body fluids of infected beauty, and the outbreak of infection between camels is a serious threat to human health.

I can't find the original Okaz article, but navigating an Arabic-language website can be tricky. It may be significant that this report cites the closeness of Okaz to the government; I read it as government approval to discuss MERS beyond the bare numbers of the daily updates.